Oral contrast-enhanced sonography for the diagnosis and grading of postsurgical recurrence of Crohnʼs disease

Abstract

Both BS and OCBS show good sensitivity and high specificity for the diagnosis of PSR in CD, with a BWT >5 mm for BS and BWT >4 mm for OCBS strongly indicative of severe endoscopic PSR. Accordingly, these techniques could replace endoscopy for the diagnosis and grading of PSR in many cases.

Severity of postoperative recurrence in crohnʼs disease: Correlation between endoscopic and sonographic findings

“…31,32 In a prospective longitudinal study, our findings supported the usefulness of SICUS for assessing CD recurrence after ileocolonic resection when using ileocolonoscopy as a gold standard. 31 This finding was confirmed by a different group, reporting that a BWT >4 mm assessed by SICUS is the best cutoff for differentiating the severity of CD recurrence.…”

“…When considering the whole group of 72 patients, the median BWT was 5 mm (range 3.5-10 mm). SICUS detected strictures in 31/72 (43%) patients, associated with bowel dilation above stricture in 16/31 (51.6%), showing a median lumen of 28 mm (range [25][26][27][28][29][30][31][32]. Different from the endoscopic score, no significant correlation was observed between the BWT and CDAI value at time of sonographic assessment (r ¼ 0.2; P ¼ 0.1).…”

“…When compared with previous findings, a lower sensitivity (82%) and a comparable PPV (93%) was observed, although associated with a higher specificity (94%) and NPV (84%). 32 Discrepancies between the 2 studies are most likely related to the different number of tested patients (72 versus 40), particularly regarding the subgroup with no recurrence (5 versus 18) and to the different time intervals from surgery. 32 In our CD population, 5 FN findings were detected by SICUS when using 3 mm as a normal cutoff value.…”

“…29,30 The use of oral contrast, together with operator experience, significantly increases the accuracy of sonographic assessment of ileal lesions in CD, [26][27][28] although only 2 studies investigated the usefulness of this technique in assessing CD recurrence. 31,32 As recent evidence supports the need of a more aggressive treatment in patients with early endoscopic recurrence, even if asymptomatic, 33,37 a noninvasive technique in the early postoperative period may identify patients at risk of a more aggressive course after surgery. These observations prompted us to investigate the possible usefulness of SICUS for assessing the postoperative recurrence of CD.…”

“…31 This finding was confirmed by a different group, reporting that a BWT >4 mm assessed by SICUS is the best cutoff for differentiating the severity of CD recurrence. 32 Current management of CD patients after curative resection includes a more aggressive medical treatment in patients with early postoperative asymptomatic recurrence, for possible relapse prevention. 33 Therefore, the development of noninvasive and repeatable techniques able to detect CD recurrence in the early postoperative period are needed for proper follow-up and treatment of resected patients.…”